THE CLINICAL ENTERPRISE: SEVEN TIPS THAT WILL HELP YOU

RUN A SMOOTH CLINIC

Robert H. Hopkins, Jr., MD, FACP, FAAPDirector, Division of General Internal Medicine

AMBULATORY OPERATIONS: SIMPLE BUT COMPLEX…-PATIENT FOCUSED BUT NEED REFINEMENT…CHANGE RATE IS VARIABLE…

WELCOME TO UAMS!!

#1 KNOW YOUR PEOPLE

• Medical Director & Department/Divison Director• Appointments/Scheduling• Set up your template with your director/administrator

• Department/Division Administrator• Appointments/Scheduling• Set up your template with your director/administrator

• Access/Appt. Center [UH, VA, ACH: Separate]• Communication!!!!• Some Departments do not use central access center• Policies: Insurance; Template formats; Hospital Follow ups

#1 KNOW YOUR PEOPLE (CONTD)

• Clinic Manager:• Learn the policies already set in place• Build and maintain a good relationship• Staffing, Rooms, Clinic metrics• Encounter Forms

• Nurses:• Communicate with them about your preferences• Time to check a patient in• Overbooks

#2 KNOW MCPG (FACULTY GROUP PRACTICE)

• The UAMS operating division that administers the business aspects of physician services, including billing, payment• Encounter Forms and Coding• Encounter forms may be paper or within EMR• This issue likely to be more uniform with Epic

implementation [next 12-18 months]

• Risk Management (dealing with problems)• Prefer to know about potential problems than to hear ‘to

late..’

#3: LEARN THE COMPUTER SYSTEMS

CENTRICITY [Current Ambulatory EMR]•To be replaced by EPIC [IP/OP] in 2013

• Development beginning now

•Not all using EMR to its capability…•Advantages

• Communication between docs• Sign off/review all OP data [minimize ‘miss’ potential]• Organized, reasonably user friendly

•Disadvantages• Typing vs. Dictating• IP and OP systems communicate but don’t integrate• IT glitches

#4: KNOW YOUR CLINIC POLICIES

• No shows• Late patients• Time allotted to each patient• Rules for canceling your clinic• Administrative dashboard [EIS]• Data on most of these clinic metrics• Reviewed routinely by admin, Dean and Dept/Divison

leadership

#5: FGP COMPLIANCE

• Learn [keep up with] changes in billing/coding • Check with your administrator re: specialty-specific tools• Please teach your learners how important/complicated this

is and can be!

• Routine random audits• Review your results, ask for a sit down if you have

concerns…When you screw up, they will find you!

#6: STUDENT/RESIDENT EDUCATION

• Most clinics serve insured and underprivileged• Institutional policy on fees/payment for services• Review specific clinic policies with your administrator

• The majority of us are on some ‘educator track’• Students, residents, fellow, [other learners]• Know rules for documentation of services w/ learners• What/how much of learner note you can refer to…• Teaching physician statements…• Primary care exemptions…

MAKE THE MOST OF TEACHING MOMENTS..

• We are all pressed by multiple demands on time • We are here b/c we have a passion for education• Most are not trained educators• Tips• Smile• Pick one teaching point from each patient encounter• One Minute Preceptor

• Share your clinical dilemma• Feedback sandwiches…

#7: GET INVOLVED

• ALWAYS opportunities for improvement!• Committees• Clinical Coordinating Committee• Medication Policy Committee• Professional Standards Committee

• Quality Improvement• Faculty Senate • EPIC development in your specialty area• Consider getting involved with reform

OVERALL….

• Introduce yourself• Consider volunteering for outreach-• Publicize what you bring to UAMS and Arkansas

• Ask questions • Be proactive

Knowledge is POWER!